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Three Quality Improvement Initiatives and Performance of Rheumatoid Arthritis Disease Activity Measures in Electronic Health Records: Results From an Interrupted Time Series Study
Author(s) -
Gandrup Julie,
Li Jing,
Izadi Zara,
Gianfrancesco Milena,
Ellingsen Torkell,
Yazdany Jinoos,
Schmajuk Gabriela
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23848
Subject(s) - rheumatoid arthritis , interrupted time series , medicine , series (stratigraphy) , health records , quality (philosophy) , electronic health record , health care , nursing , biology , economics , economic growth , paleontology , philosophy , epistemology , psychological intervention
Objective Applying treat‐to‐target strategies in the care of patients with rheumatoid arthritis ( RA ) is critical for improving outcomes, yet electronic health records ( EHR s) have few features to facilitate this goal. We undertook this study to evaluate the effect of 3 health information technology (health‐ IT ) initiatives on the performance of RA disease activity measures and outcomes in an academic rheumatology clinic. Methods We implemented the 3 following initiatives designed to facilitate performance of the Clinical Disease Activity Index ( CDAI ): an EHR flowsheet to input scores, peer performance reports, and an EHR SmartForm including a CDAI calculator. We performed an interrupted time‐series trial to assess effects on the proportion of RA visits with a documented CDAI . Mean CDAI scores before and after the last initiative were compared using t ‐tests. Additionally, we measured physician satisfaction with the initiatives. Results We included data from 995 patients with 8,040 encounters between 2012 and 2017. Over this period, electronic capture of CDAI scores increased from 0% to 64%. Performance remained stable after peer reporting and the SmartForm were introduced. We observed no meaningful changes in disease activity levels. However, physician satisfaction increased after SmartForm implementation. Conclusion Modifications to the EHR , provider culture, and clinical workflows effectively improved capture of RA disease activity scores and physician satisfaction, but parallel gains in disease activity levels were missing. This study illustrates how a series of health‐ IT initiatives can evolve to enable sustained changes in practice. However, capture of RA outcomes alone may not be sufficient to improve levels of disease activity without a comprehensive treat‐to‐target program.